# The value of peripheral blood PLR, Lp-PLA2, MHR, SII, and HCY in assessing the rupture risk of small and medium-sized intracranial aneurysms

## TL;DR

This study explores blood markers that may help predict if small or medium brain aneurysms are likely to rupture.

## Contribution

A combined multi-biomarker nomogram was developed to predict rupture risk in intracranial aneurysms.

## Key findings

- PLR, Lp-PLA2, MHR, SII, and HCY were significantly higher in ruptured aneurysm cases.
- A predictive nomogram showed strong discrimination (AUC = 0.969) for rupture risk.
- The model requires validation in larger, multicenter studies for generalizability.

## Abstract

We aimed to investigate the relationship of peripheral blood platelet-to-lymphocyte ratio (PLR), lipoprotein-associated phospholipase A2 (Lp-PLA2), monocyte-to-high-density lipoprotein ratio (MHR), systemic immune-inflammation index (SII), and Homocysteine (HCY) with risk of rupture for small to medium-sized intracranial aneurysms, and examine their combined value as potential predictive markers.

We conducted a retrospective analysis of clinical data from 80 patients with intracranial aneurysms who underwent endovascular embolization from January 2022 to January 2025. Patients were divided into a ruptured group (n = 27) and an unruptured group (n = 53). Associations between biomarkers and rupture status were evaluated using univariate and multivariate logistic regression. A predictive nomogram was constructed and assessed using calibration, receiver operating characteristic (ROC) curve analysis, decision curve analysis (DCA), and bootstrap internal validation.

Levels of PLR, Lp-PLA2, MHR, SII, and HCY were significantly higher in ruptured cases, while SOD and IL-10 were significantly lower (p < 0.05). In multivariable logistic regression, all five biomarkers were associated with rupture. The combined biomarker model showed high apparent discrimination (AUC = 0.969) and was internally validated using bootstrap resampling; however, given the small, single-center sample and the lack of adjustment for key clinical and morphological predictors, the model requires cautious interpretation and independent validation.

PLR, Lp-PLA2, MHR, SII, and HCY were associated with rupture status in small to medium-sized intracranial aneurysms. A combined multi-biomarker nomogram showed strong apparent discrimination; however, the incremental value beyond established clinical and morphological predictors and the generalizability of this model need confirmation in larger, preferably multicenter cohorts.